Are patients with hypermobile Elhers-Danlos syndrome or hyermobility spectrum disorder so different?

by ptfadmin | Apr 24, 2025 | Health Tips

Reviewed by Tyler Tice, PT, DPT, OCS, ATC

Introduction

Joint hypermobility disorders affect a smaller portion of the population, but when symptomatic they can have a major effect on quality of life. More severe hypermobility disorders, such as Hypermobile Ehlers-Danlos Syndrome (EDS) can be difficult to diagnose and distinguish from newly named disorders such as Hypermobility Spectrum Disorder (HSD). Due to their perceived similarities, this article strives to compare the two disorders (EDS and HSD) to determine if they present similarly and therefore can be treated similarly.

Methods

The study included 97 adult patients with symptomatic generalized hypermobility syndrome recruited by physiotherapists, physiatrists, rheumatologists, and other health care professions. Variable used in the study included the 2017 diagnostic criteria for hypermobile EDS (hEDS), symptom severity (using quantitative and qualitative measures), and extra-articular manifestations. Those that did not fit the 3 criteria for hEDS were classified as having HSD. Patients were assessed at three times: baseline, 6 months, and more than 12 months. Following a PT eval, each patient was provided with a POC with a focus on body awareness or proprioception, low resistance exercises to strengthen deep and stabilizer muscles in closed or semi-closed chain.

Results

Out of 97 patients, 61 were classified as having hEDS, and the others (36) classified as having HSD. The median age of participants was 41 years old and overwhelmingly female (93%). Those classified as having hEDS had a higher Beighton score, more family history of the condition, and more musculoskeletal pain, more occurrence of chronic or recurrent dislocations than those classified with HSD. At 6 months, 37% of 76 patients not lost to follow up considered improvement in their condition. After 12 months, 54% of 59 patients not lost to follow up considered improvement in their condition. Improvement at 12 months were associated with the following factors: initial pain intensity, sleep disturbance, family history of hypermobility.

Discussion

According to this study, physical therapy is beneficial in patient symptoms for about half of those with hEDS and HSD. It remains difficult to determine significant difference in symptoms between the two groups: hEDS and HSD. Within both groups, a similar amount (about 50%) reported similarities of chronic pain symptom/problem, and neuropathic pain. This study suggests that the diagnosis (hEDS vs. HSD) does not predict outcomes following participation in physical therapy. Limitations of this study include, French/English speaking participants within a specific area of Switzerland, disproportionate ratio of females to males, and subjective data sets.

Conclusion

Using the 2017 criteria for diagnosing hEDS and HSD, this study found that the two groups presented similarly in symptom severity and limitations. About 50% of all participants believed they experienced some improvement in symptoms with PT. In conclusion, these groups can be treated similarly in the PT setting.

Reference

Aubry-Rozier, B., Schwitzguebel, A., Valerio, F., Tanniger, J., Paquier, C., Berna, C., Hugle, T., & Benaim, C. (2021). Are patients with hypermobile Ehlers-Danlos syndrome or hypermobility spectrum disorder so different? Rheumatology International, 2021(41), 1785-1794. https://doi.org/10.1007/s00296-021-04968-3

Effect of Scapular Stabilization on Frozen Shoulder Syndrome

by ptfadmin | Apr 17, 2025 | Health Tips

Pelvic Floor Disorders and Low Back Pain: Innovative Approaches to Physical Therapy

by ptfadmin | Apr 10, 2025 | Health Tips

Reviewed by Tyler Tice, PT, DPT, OCS, ATC

Introduction

Pelvic floor dysfunction (PFD) and chronic low back pain (CLBP) often coexist due to overlapping biomechanical, neuromuscular, and pain mechanisms.¹ These conditions affect movement patterns, core stability, and quality of life, presenting a unique challenge for physical therapy. While traditional pelvic floor muscle (PFM) exercises, such as Kegels, remain a cornerstone for treating PFD, emerging research suggests that functional and specialized exercises may offer superior engagement and adherence.^2,3 This review integrates findings from recent studies exploring the connection between PFD and CLBP while proposing alternative exercise methods to enhance pelvic floor rehabilitation outcomes.

 Pelvic Floor Dysfunction and Low Back Pain: Shared Pathways

A study by Algudairi et al. highlighted the prevalence of PFD among women with CLBP, with 43% reporting at least one pelvic floor symptom and 52% exhibiting neuropathic pain (NP). NP was strongly associated with greater pelvic floor distress, as measured by the Pelvic Floor Distress Inventory.¹ The findings suggest that PFD exacerbates CLBP through mechanisms such as central sensitization and impaired core stability. This highlights the importance of addressing both pelvic and lumbar dysfunctions in a comprehensive rehabilitation plan.

 Functional Exercises for Pelvic Floor Muscle Activation

Traditional PFM exercises, such as Kegels, rely on isolated contractions to strengthen the pelvic floor. However, Díaz-Mohedo et al. demonstrated that functional movements like trunk stability push-ups (PU) achieve PFM activation levels comparable to or exceeding those of Kegel exercises.² Using electromyography (EMG), the study revealed that PUs produced high PFM activation (112% of maximal voluntary contraction), highlighting the benefits of functional exercises in training the pelvic floor indirectly. Such exercises, which simultaneously target core and pelvic floor stability, offer a practical alternative for individuals struggling with adherence to isolated PFM exercises.² Similarly, Crawford et al. compared traditional Kegel exercises to specialized movements designed to naturally engage the pelvic floor. Using wireless surface EMG sensors, the study analyzed ten dynamic movements, including lunges, squats, and bridges. Results showed that all ten movements significantly increased PFM activation compared to isolated Kegels. For example, bridges produced a 56% greater activation; while hovering exercises achieved a 49% increase.³ These findings suggest that incorporating PFM contractions into functional and dynamic tasks can enhance motor unit recruitment and improve training efficiency.

 Pelvic Floor Training and Chronic Low Back Pain Management

Functional exercises that engage PFMs indirectly, such as lunges, squats, and push-ups, not only strengthen the pelvic floor but also address core stability deficits commonly observed in CLBP patients. Additionally, incorporating specialized movements that synchronize PFM contractions with dynamic tasks—such as bridges and cat-cow stretches—provides a more comprehensive approach to improving lumbopelvic stability. Neuropathic pain, often associated with PFD, can further complicate CLBP treatment. Algudairi et al. emphasized the importance of addressing NP through multimodal interventions, including pain education, graded motor imagery, and myofascial release. Combining these strategies with dynamic PFM training offers a pathway to manage both pelvic and lumbar dysfunctions effectively.

Conclusion and Implications for Physical Therapy

The integration of functional and dynamic PFM exercises represents a shift in the management of PFD and its associated low back pain. Studies by Díaz-Mohedo et al. and Crawford et al. demonstrate that functional movements like bridges, squats, and push-ups can significantly enhance PFM activation, outperforming traditional Kegels in many cases. These exercises also promote broader neuromuscular adaptations, addressing core stability deficits and improving adherence by embedding pelvic floor training into everyday movement patterns.

Physical therapists can leverage these findings to develop individualized rehabilitation programs that address both PFD and CLBP. Functional PFM training can be incorporated into standard protocols, complemented by interventions targeting neuropathic pain and compensatory movement patterns. This comprehensive approach not only optimizes pelvic and lumbar health but also enhances overall functional outcomes, reducing the risk of recurrence and improving quality of life for patients.

References

1. Algudairi G, Aleisa E, Al-Badr A. Prevalence of neuropathic pain and pelvic floor disorders among females seeking physical therapy for chronic low back pain. Urol Ann. 2019;11(1):20-26. doi:10.4103/UA.UA_123_18
2. Díaz-Mohedo E, Odriozola Aguirre I, Molina García E, Infantes-Rosales MA, Hita-Contreras F. Functional Exercise Versus Specific Pelvic Floor Exercise: Observational Pilot Study in Female University Students. Healthcare (Basel). 2023;11(4):561. doi:10.3390/healthcare11040561
3. Crawford B. Pelvic floor muscle motor unit recruitment: Kegels vs specialized movement. American Journal of Obstetrics & Gynecology. 2016. Accessed January 25, 2025. https://www.ajog.org/article/S0002-9378(16)00035-1/fulltext

Utilizing Scapular Stabilization Exercises in a Patient with Medical Epicondylalgia

by ptfadmin | Apr 3, 2025 | Health Tips

Reviewed by Tyler Tice, PT, DPT, OCS, ATC

Introduction/Background

Goldfard et al., presents a case study on the application of scapular stabilization exercises to treat medial epicondylalgia. In 2013, Bhatt et al proposed a case study proposing that improving scapular stability could lead to reduced loading of forearm musculature during functional tasks. They mentioned previous studies that have demonstrated positive outcome using scapular stabilization exercises in patients with lateral epicondylalgia. This case report aims to describe the utilization of a scapular stabilization program for a patient with medial epicondylalgia.

Case Presentation and Treatment

A 52-year-old female patient presented to physical therapy with medial elbow pain. Pt reported gradual, insidious onset that was worse with activities that involved elbow flexion, such as lifting and swimming. The patient underwent an 8-week scapular stabilization program. Assessments included a shortened form of the Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH) score, pain levels, and manual muscle testing (MMT) of the elbow, wrist, and forearm, all measure baseline, discharge, and 1-month follow-up. Elbow, forearm, except for wrist flexion (4/5) was determined to be (5/5) on MMT. Valgus stress, valgus overhead, and varus stress tests examined ligamentous integrity, and all were found to be negative.

The 8-week treatment plan consisted only of exercises targeting the middle and lower trapezius and rhomboid strength and endurance, as well as dynamic scapular motor control during functional exercises. With the primary goal to control scapular anterior tipping during resisted elbow flexion- an underlying factor that contributes to the patient’s medial elbow pain. Exercises were broken into 3 phases staring with exercises done in prone with dumbbells and progressed to standing with resistance bands, ensuring proper form was maintained throughout all repetitions.

Outcome/Follow up

Clinically meaningful improvements in pain (d/c 0, 1-mo f/u 0), the QuickDASH (d/c 9.32, 1- mo f/u 4.55), and wrist strength (d/c 5/5, 1-m0 f/u 5/5) were observed at the 1-month follow-up. The patient was able to perform resisted elbow flexion without demonstrating any compensatory anterior tipping and was also able to return to all her previous activities.

Discussion

The case suggests that scapular stabilization exercises may be beneficial in treating medical epicondylalgia, as evidenced by improvements in pain, wrist flexion strength, and activity tolerance. Consider assessing scapular strength and motor control in patients with medial epicondylalgia and monitor for scapular compensatory movements while assessing upper extremity strength.

References

Goldfard, J., Grimes, J. K., & Bauer, P. (2021). Utilizing scapular stabilization exercises in a patient with medial epicondylalgia: A case report. JOSPT Cases, 1(2), 1-8. https://doi.org/10.2519/josptcases.2021.9980

Well-Tolerated Strategies for Managing Knee Osteoarthritis

by ptfadmin | Mar 27, 2025 | Health Tips

Reviewed by Kirsten Hales, SPT

Introduction

 Knee osteoarthritis (OA) is a prevalent musculoskeletal condition, commonly leading to pain, stiffness, and functional limitations, especially in older adults. While pharmacological treatments like pain relievers and anti-inflammatory medications are frequently used, non-pharmacological approaches such as physical therapy are essential for long-term management. The article “Well-Tolerated Strategies for Managing Knee Osteoarthritis: A Manual Physical Therapist Approach to Activity, Exercise, and Advice,” by Deyle and Gill (2012), explores manual physical therapy, exercise, and patient education as effective strategies for managing knee OA symptoms. This review aims to evaluate the article’s key findings and contributions to knee OA management.

Methods

 The article provides a comprehensive overview of evidence-based strategies for managing knee OA. The authors reviewed multiple studies and clinical evidence to support the effectiveness of manual therapy, exercise, and patient education. These strategies were analyzed for their ability to alleviate pain, improve joint mobility, and enhance overall function in individuals with knee OA.The article highlights the best practices for physical therapists, covering exercise recommendations, manual therapy techniques, and behavioral changes.

Results

• Manual Therapy: The use of joint mobilizations and soft tissue techniques was shown to reduce pain and increase mobility in patients with knee OA. The authors emphasized that manual therapy could provide immediate symptomatic relief and improve range of motion when combined with other interventions.
• Exercise Therapy: A combination of strengthening exercises for the quadriceps and aerobic activities was identified as crucial for reducing pain and improving functional outcomes. The article mentioned that exercises should be customized to each patient’s needs, with a focus on gradual progression to prevent worsening symptoms.
• Patient Education: Teaching patients about the importance of staying active, modifying daily activities to minimize joint strain, and incorporating weight management strategies were key components of successful treatment.
• Progressive Load Management: The article discussed the importance of increasing exercise intensity over time, ensuring patients do not overload the joint but are progressively challenged to improve strength and function.

Discussion

The authors concluded that a combination of manual therapy, exercise, and patient education provides a well-rounded, effective approach to managing knee OA. Manual therapy helps reduce immediate pain and stiffness, while exercise promotes long-term improvements in joint function and strength. The authors also highlighted the critical role of patient education in helping individuals manage their condition, maintain physical activity, and prevent further joint degeneration.

However, the authors also noted some limitations. While the evidence supports the benefits of these interventions, they acknowledged that more research is needed to determine the most effective protocols for specific patient populations, including those with varying levels of severity in OA. The differences in exercise routines and manual therapy techniques across studies makes it challenging to create a standardized treatment protocol.

Conclusion

The article provided strong evidence for the efficacy of manual therapy, exercise, and patient education in managing knee OA. For clinicians, it serves as a valuable resource in developing treatment plans that emphasize non-invasive, well-tolerated interventions. Incorporating these strategies into rehabilitation programs can significantly improve outcomes for patients with knee OA. As a student physical therapist, I have observed the positive impact of combining these approaches in clinical practice. The focus on individualized care is particularly important, as knee OA affects patients in many different ways. However, like the authors, I believe more research is needed to determine optimal exercise protocols and to assess long-term outcomes. In the meantime, the comprehensive approach outlined in this article is an excellent foundation for treating knee OA in clinical settings.

Reference

Deyle, G. D., & Gill, N. W. (2012). Well-Tolerated Strategies for Managing Knee Osteoarthritis: A Manual Physical Therapist Approach to Activity, Exercise, and Advice. The Physician and Sportsmedicine, 40(3), 12–25. https://doi.org/10.3810/psm.2012.09.1976